Huang Lei, Wu Jian-Qiang, Han Bing, Wen Zhi, Chen Pei-Rui, Sun Xiao-Kang, Guo Xiang-Dong, Zhao Chang-Ming
Department of Cardiothoracic Surgery, Deyang People's Hospital, Deyang 618000, Sichuang Province, China.
World J Clin Cases. 2019 Feb 6;7(3):291-299. doi: 10.12998/wjcc.v7.i3.291.
The main clinical treatment for esophageal cancer is surgery. Since traditional open esophageal cancer resection has the disadvantages of large trauma, long recovery period, and high postoperative complication rate, its clinical application is gradually reduced. The current report of minimally invasive Ivor-Lewis esophagectomy (MIILE) is increasing. However, researchers found that patients with MIILE had a higher incidence of early delayed gastric emptying (DGE).
To investigate the influencing factors of postoperative early DGE after MIILE.
A total of 156 patients diagnosed with esophageal cancer at Deyang People's Hospital were enrolled. According to the criteria of DGE, patients were assigned to a DGE group ( = 49) and a control group ( = 107). The differences between the DGE group and the control group were compared. Multivariate logistic regression analysis was used to further determine the influencing factors of postoperative early DGE. The receiver operating characteristic (ROC) curve was used to assess potential factors in predicting postoperative early DGE.
Age, intraoperative blood loss, chest drainage time, portion of anxiety score ≥ 45 points, analgesia pump use, postoperative to enteral nutrition interval, and postoperative fluid volume in the DGE group were higher than those in the control group. Perioperative albumin level in the DGE group was lower than that in the control group ( < 0.05). Age, anxiety score, perioperative albumin level, and postoperative fluid volume were independent factors influencing postoperative early DGE, and the differences were statistically significant ( < 0.05). The ROC curve analysis revealed that the area under the curve (AUC) for anxiety score was 0.720. The optimum cut-off value was 39, and the sensitivity and specificity were 80.37% and 65.31%, respectively. The AUC for postoperative fluid volume were 0.774. The optimal cut-off value was 1191.86 mL, and the sensitivity and specificity were 65.3% and 77.6%, respectively. The AUC for perioperative albumin level was 0.758. The optimum cut-off value was 26.75 g/L, and the sensitivity and specificity were 97.2% and 46.9%, respectively.
Advanced age, postoperative anxiety, perioperative albumin level, and postoperative fluid volume can increase the incidence of postoperative early DGE.
食管癌的主要临床治疗方法是手术。由于传统开放性食管癌切除术具有创伤大、恢复时间长和术后并发症发生率高的缺点，其临床应用逐渐减少。目前关于微创Ivor-Lewis食管切除术（MIILE）的报道越来越多。然而，研究人员发现MIILE患者早期胃排空延迟（DGE）的发生率较高。
探讨MIILE术后早期DGE的影响因素。
共纳入德阳市人民医院确诊为食管癌的156例患者。根据DGE标准，将患者分为DGE组（n = 49）和对照组（n = 107）。比较DGE组和对照组之间的差异。采用多因素logistic回归分析进一步确定术后早期DGE的影响因素。采用受试者操作特征（ROC）曲线评估预测术后早期DGE的潜在因素。
DGE组患者的年龄、术中出血量、胸腔引流时间、焦虑评分≥45分的比例、镇痛泵使用情况、术后开始肠内营养的间隔时间以及术后补液量均高于对照组。DGE组围手术期白蛋白水平低于对照组（P < 0.05）。年龄、焦虑评分、围手术期白蛋白水平和术后补液量是影响术后早期DGE的独立因素，差异有统计学意义（P < 0.05）。ROC曲线分析显示，焦虑评分的曲线下面积（AUC）为0.720。最佳截断值为39，灵敏度和特异度分别为80.37%和65.31%。术后补液量的AUC为0.774。最佳截断值为1191.86 mL，灵敏度和特异度分别为65.3%和77.6%。围手术期白蛋白水平的AUC为0.758。最佳截断值为26.75 g/L，灵敏度和特异度分别为97.2%和46.9%。
高龄、术后焦虑、围手术期白蛋白水平和术后补液量可增加术后早期DGE的发生率。
